Provider Demographics
NPI:1255303988
Name:ILINSKY, ALLA (DDS)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:ILINSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1747 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5016
Mailing Address - Country:US
Mailing Address - Phone:718-331-3563
Mailing Address - Fax:866-590-9641
Practice Address - Street 1:1747 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5016
Practice Address - Country:US
Practice Address - Phone:718-331-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0442201223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01351115Medicaid